Case of the Month

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1,200 Hours Short of a Certificate

Oct 19, 2018

The Case

In April the College received an application for an Independent Practice Certificate from LM—however she had not completed 1,200 practice hours or the Physiotherapy Competency Exam (PCE) within the previous five years, as required by the College’s Registration Regulation.

In 2009 LM got a degree in physiotherapy from McMaster University and successfully completed the Physiotherapy Competency Exam before registering with the College from 2009 until 2017. During the 2016 renewal period, College staff identified LM as having low practice hours—a total of 587 over a four-year period. She was given the opportunity to participate in a practice review including an on-site assessment to ensure competency, but she resigned from the College and moved out of country in 2017.

In a written submission to the College, LM indicated that she was unable to fulfill the practice hour requirement due to raising a family and moving out of country for her partner’s work. She further stated her desire to return to practice with a focus on orthopaedics and pelvic floor physiotherapy and indicated that she had completed courses related to pelvic health in anticipation.

The Rules

Registration requirements allow the College to verify the competency of physiotherapists in Ontario including: education history, examination results and currency of skills and knowledge.

Individuals who are renewing or re-applying for an Independent Practice Certificate are required to demonstrate competency in one of two ways:

Successful completion of the Physiotherapy Competency Exam within the previous five years

The accumulation of 1,200 practice hours within the previous five years

When an applicant has not met the requirements, the College has no way of assessing their ability to practice physiotherapy in a safe, competent and effective manner. In some cases the College may decide to grant an Independent Practice Certificate of Registration with Terms, Conditions and Limitations in lieu of the above-mentioned registration requirements.

The Outcome

In LM’s case, the College decided to proceed with an Independent Practice Certificate with Terms, Conditions and Limitations in place including:

The successful completion of the Jurisprudence Education Module within 30 days of receiving their Certificate

Review College Standards, tools and resources within 30 days of receiving the Certificate and provide confirmation of completion

Work the first 80 hours of practice under direct supervision of a College-approved Supervisor rostered to assess and rehabilitate pelvic musculature

During the first 80 hours of practice the supervising physiotherapist will review all of LM’s clinical records to ensure compliance with professional expectations

Successfully complete a practice assessment at the end of the supervision period

All costs associated with the practice review will be paid for by LM

The College believes that these Terms, Conditions and Limitations will ensure that the PT has the support required for a successful return to practice in Ontario. The Terms, Conditions and Limitations will be removed from LM’s Certificate of Registration upon successful completion.

The 1200 practice hours accrued over the last 5 years, the benchmark used to determine competency is archaic and has been in place for a very long time. In my opinion it does not provide any protection to the public, which is the primary mandate of the College; the rules and legislation, as they currently stand, do not guarantee a physiotherapist’s clinical competency and this can in fact pose a large risk to the public, as the hours can be collected by physiotherapists in a variety of roles (including non-clinical roles) and physiotherapists are not required to partake in continuing education that pertains to maintaining clinical competency. In essence, a physiotherapist can be in an administrative role for 25 years and return to clinical care without any questions asked or their clinical competency examined, even if at that point they have not seen a patient in those 25 years and have not maintained/updated their clinical knowledge and skills, focusing on the administrative aspects of their career. Having the 1200 ‘practice’ hours in the past five years while solely in a non-clinical role does not provide a check and balance on clinical competency and is not a valuable tool to allow physiotherapists to provide clinical care and maintain their membership in the Independent Practice category. It is unbelievable that as a physiotherapist transitions from an administrative role to a clinical role, that the number of hours of clinical care and continuing education/continuing competency pertaining to clinical care are not addressed by College rules and regulations. I do not see how the public’s interest is protected with the College’s policies as they currently stand.